Hesperian Health Guides
Medicines for HIV – Antiretroviral Therapy (ART)
Taking antiretroviral medicines helps many people live with HIV and stay healthy. They are taken as a combination of several medicines, which is called Antiretroviral Therapy, or ART. These medicines do not cure HIV and must be taken without interruption to keep working.
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HIV care and ART programs
HIV is a complicated disease that affects every part of your body. As soon as you have a positive HIV test, try to find an HIV care program that can provide medicines to prevent and treat HIV illnesses, counseling and other support. They can help you start ART and manage any possible side effects. Getting drugs from an ART program is more reliable and less costly than buying them from a private source.
When is ART needed?
Anyone who who tests positive for HIV should start taking ART as soon as possible, to avoid becoming ill.
Anyone with HIV and active TB or hepatitis B infection should take ART.
If you are pregnant and test positive for HIV, you should start ART as soon as possible.
Before starting ART, a health worker may ask you:
- if you have ever taken ART before. This may affect what medicines you should take now.
- if you have any illnesses or serious infections such as pneumonia. These may need to be treated first.
- if you understand the benefits, risks, and possible side effects of ART. It is often helpful to talk to someone who is already using ART as well as your health worker.
- if you are able to take medicines every day, at the right times, which is necessary for ART to work.
- if you have told at least one person that you have HIV, so you have support in case something prevents you from getting or taking your medicines, for example.
- if there is an HIV support group you can join for information and help.
Ask the health worker if there will be a steady supply of the medicines you need.
Do not start taking ART on your own. You may take the wrong medicines, which can have serious side effects or cause drug resistance.
Do not share your ART medicines with anyone. ART will not work if you take less than the recommended dose.
Do not buy ART from someone who is not part of an HIV treatment program.
How to take ART
ART is effective only in combinations (regimens) of at least 3 medicines. Some medicines may be combined into 1 or 2 tablets or capsules so there are fewer pills to take. This makes taking medicines every day easier. The combinations described below are widely available, have fewer side effects, and are safer. Depending on what is available where you live, the combination of medicines you take or how often you take them may be different.
- Whatever combination you use, take each medicine carefully, as directed.
- Twice-a-day medicines should be taken every 12 hours. For example, if you take the first dose at 6:00 in the morning, then the second dose should be taken at 6:00 in the evening. Some medicines need to be taken only once a day.
- Once-a-day medicines should be taken at close to the same time each day.
Side effects of ART
ART can have side effects. Some side effects decrease and go away completely with time. Others appear only after you have taken a medicine for a long time. Some common side effects are bothersome but are not serious, such as diarrhea, tiredness, headaches, and stomach problems. Talk to your health worker and other people taking ART about how to handle these problems. Keep taking all your medicines until your health worker tells you to change or stop.
Other side effects can be life-threatening, such as severe liver problems, severe tiredness with shortness of breath, skin allergies and rashes, tingling or burning in the hands and feet, and anemia. If you have serious side effects, see a health worker right away.
Preventing HIV soon after you have been exposed (PEP)
When someone is exposed to HIV, for example when a health worker is stuck with a needle or someone is raped by a person who may have HIV, you can prevent getting HIV by taking ART medicines for a short time. This is called post-exposure prophylaxis, or PEP.
If you may have been exposed to HIV (see how HIV can spread), talk with a health worker you trust as soon as possible about whether you can take PEP. You should start taking PEP within a few hours of exposure, and no later than 3 days after you were exposed. Start one of the ART combinations below, preferably Combination 1 or Combination 2. Other combinations may be available and recommended in your area. Take whatever combination you use for 28 days.
Preventing HIV before and during exposure (PrEP)
Someone who does not have HIV may be regularly exposed to it from a partner or at work. To protect against HIV infection, they can use pre-exposure prophylaxis (PrEP). PrEP is a combination of 2 ART medicines usually taken every day.
| PrEP Combination 1 | PrEP Combination 2 |
| tenofovir (TDF) 300 mg once a day + emtricitabine (FTC) 200 mg once a day |
tenofovir (TDF) 300 mg once a day + lamivudine (3TC) 300 mg once a day |
ART Combinations for people 11 years old and older
| Combination 1 | ||
|---|---|---|
| Medicines | Dose | Things you should know |
|
300 mg once a day | Can cause kidney problems. |
|
300 mg once a day | |
| or | or | |
|
200 mg once a day | |
|
50 mg once a day. | Can cause sleep problems, mood changes, dizziness. Safe to use during pregnancy and breastfeeding. |
| Combination 2 | ||
| Medicines | Dose | Things you should know |
|
300 mg once a day | Can cause kidney problems. |
|
300 mg once a day | |
| or | or | |
|
200 mg once a day | |
|
1 tablet of 400 mg lopinavir/100 mg ritonavir 2 times a day | Can cause liver problems. Safe to use during pregnancy. |
| Combination 3 | ||
| Medicines | Dose | Things you should know |
|
250 to 300 mg 2 times a day | Can cause anemia and low white blood count. |
|
150 mg 2 times a day, or 300 mg once a day | |
|
200 mg once a day for 14 days, then 200 mg 2 times a day | Can cause liver problems and skin rash |
| Combination 4 | ||
| Medicines | Dose | Things you should know |
|
250 to 300 mg 2 times a day | Can cause anemia and low white blood count. |
|
150 mg 2 times a day, or 300 mg once a day | |
|
400 mg once a day | Makes hormonal birth control less effective. Can cause dizziness, confusion, and mood changes. Good choice for people with kidney disease and people over 50 years old. |
Drug resistance – first and second line combinations
The ART you start on is called a first line combination, or first line regimen. Over a period of years, HIV can become resistant to ART. Many people may need to switch to a second line of drugs. Talk to your health worker about which drugs work in your area and if you need to change.
ART during pregnancy
All pregnant people who have HIV should start ART to maintain or improve their health. ART will also help prevent HIV from spreading to the baby.
Someone who is already on ART when they become pregnant should continue taking it throughout pregnancy, during the birth, while breastfeeding, and for the rest of their life.
Preventing HIV in babies
Taking ART during pregnancy and birth protects a developing baby from getting an HIV infection, but medicines are only part of protection. Safer sex during pregnancy, safe birth practices, careful feeding of the baby, and treatment of illnesses in both the birth parent and baby also matter.
After birth, the baby will also need either 1 or 2 ART medicines:
Give the baby only nevirapine for 6 weeks if the birth parent started taking ART before pregnancy or very early in the pregnancy.
Give the baby both nevirapine and zidovudine for 6 weeks if:
- the birth parent started taking ART less than 1 month before the birth.
- the birth parent thinks they were infected with HIV during pregnancy or breastfeeding.
- the birth parent has a lot of HIV in their blood (a viral load over 1000) or feels very sick.
If the birth parent is breastfeeding, continue giving the baby either nevirapine or zidovudine for an additional 6 weeks.
If the birth parent stops taking ART while breastfeeding, begin giving the baby nevirapine again. You can stop giving the baby nevirapine 6 weeks after the birth parent restarts ART, or a week after they stop breastfeeding.
Everyone should have access to ART medicines
Treatment Action Campaign (TAC) started in 1998 when a small group of activists in Cape Town, South Africa, demanded treatment for people living with HIV. Even though it was common in Europe, the US, and other Western countries, many people in South Africa did not know that medicines could treat HIV and help people live longer.
For many years, TAC organized people in support groups and local organizations through HIV education workshops, marches, protests, and legal actions to make HIV treatment more available, and to fight discrimination against people with HIV. TAC now has 16,000 members. One of TAC’s first successful campaigns was to sue the government of South Africa to provide treatment for women with HIV so their babies would not be born with HIV.
Recently, TAC has begun to focus on the problems in their public health system that make treatment less accessible, such as corruption and poor management. Good guidelines and policies are not enough if the health system is broken.
Each of TAC’s 200 branches across the country have adopted a clinic where members monitor services and provide support. If problems cannot be resolved locally, TAC helps raise them at the district level or higher to find a solution.
Secretary General of TAC